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‘Breakthrough’ in Fertility Preservation for Breast Cancer Patient

French physicians on Wednesday described the first case of an infertile cancer patient giving birth after her immature eggs were further matured via in vitro maturation (IVM) and subsequently frozen.

After receiving a breast cancer diagnosis, the woman was provided with fertility counseling, wherein she opted for the IVM and vitrification process prior to undergoing chemotherapy. Five years later the eggs were thawed and fertilized, and at age 34 she gave birth to a healthy boy, reported Michaël Grynberg, MD, PhD, of Antoine Béclère University Hospital in France, and colleagues in a letter to Annals of Oncology.

“This success represents a breakthrough in the field of fertility preservation,” Grynberg said in a statement. “IVM enables us to freeze eggs or embryos in urgent situations or when it would be hazardous for the patient to undergo ovarian stimulation. In addition, using them is not associated with a risk of cancer recurrence.”

As the patient had hormone-positive disease with nodal involvement, ovarian stimulation to produce mature oocytes was not considered an option for oncologic reasons, and though offered ovarian tissue cryopreservation in addition to IVM, she rejected this option as being too invasive so soon after her cancer diagnosis.

“Egg or embryo vitrification after ovarian stimulation is still the most established and efficient option. However, for some patients, ovarian stimulation isn’t feasible due to the need for urgent cancer treatment or some other contraindication,” explained Grynberg. “In these situations, freezing ovarian tissue is an option but requires a laparoscopic procedure and, in addition, in some diseases it runs the risk of re-introducing malignant cells when the tissue is transplanted back into the patient.”

Following surgery but prior to adjuvant chemotherapy, physicians performed a transvaginal ultrasound-guided procedure on the 22nd day of the patient’s cycle and removed seven immature eggs from her ovaries. After the 2-day IVM process, six eggs were frozen.

All six ultimately survived the thawing process and five were successfully fertilized with intracytoplasmic sperm injection. After 3 days of progesterone, an embryo was transferred into the patient’s uterus.

Jovana Lekovich, MD, of Icahn School of Medicine at Mount Sinai in New York City, told MedPage Today by email that IVM could be a potential option for certain cancer patients who cannot undergo “non-experimental” methods of fertility preservation.

“That being said, for the average patient, experimental advances in precision medicine should be taken with caution, given that we don’t have enough data at this time,” said Lekovich, who also directs the oncofertility program at Reproductive Medicine Associates of New York. “What makes this case report so special is the fact that the patient underwent IVM of oocytes in the setting of cancer (whereas all the other cases in the past have been pursued for other indications, including ovarian hyperstimulation syndrome and [polycystic ovary syndrome]), and that the eggs have been frozen upon IVM.”

“We sincerely look forward to further evaluating the efficacy of this technology in cancer patients,” Lekovich continued. “As you can imagine, this is a fragile patient population which we always strive to treat using proven as opposed to experimental methods whenever possible, but this sentinel case report opens the door for new strategies.”

The authors reported no conflicts of interest.


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